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Wayne Automatic Fire Sprinklers, Inc. is proud that our success is the result of the quality of our team members. We are an equal employment opportunity and affirmative action employer as well as a drug-free workplace. Please answer all questions completely and state “N/A” if question is not applicable.

Position(s) applied for:*

Department

Date of Application*

At which branch location(s) are you interested in employment?*

Orlando, FL

Jacksonville, FL

Pompano, FL

Tampa, FL

Ft. Myers, FL

Concord, NC

Type of Employment Desired*

Full Time

Part Time

Salary Expectation*

Date Available to Start*

Referral Source

Referral Sources*

Advertisement

Walk-in

Internet

Employment Agency

Job Fair/Newspaper

Relative

Team Member

Other

Additional Information about referral source

Personal Information

Name*

Last, First, Middle, Nickname

Address*

Street AddressAddress Line 2CityStateZIP Code

Home Phone

Cell Phone

Email

General Questions

If necessary, can you provide proof that you are over any minimum work age requirement?*

Yes

No

Have you ever been employed by Wayne Automatic Fire Sprinklers, Inc.?*

Yes

No

If yes, please give the dates of your employment.

From: To:

Are you legally eligible to work in the United States?*

Yes

NO

(Proof of citizenship status/identity required upon hire.)

Can you work out of town for extended periods of time if the job requires it?*

Yes

No

Will you work overtime if the job requires it?*

Yes

No

Are there any days or times you are not available to work?*

Yes

No

If yes, when?

(Reasonable accommodation of religious needs that do not create an undue hardship will be considered, if applicable).

May we contact your present employer for a reference at this time?*

Yes

No

If no, when?

How much time have you lost from work during the past 12 months?*

Are you presently an officer or employee of another business with whom we compete?*

Yes

No

If yes, please explain:

Have you ever been terminated or asked to resign from a job?*

Yes

No

Please explain:

Why do you want to work at Wayne Automatic Fire Sprinklers, Inc.?*

Please list any certificates or licenses you hold; specialized training you have completed; equipment you have operated; professional, trade, business, or civic activities you’ve been involved in; foreign languages you speak; and software programs you are proficient in.

Information About Your Past

Have you ever been convicted of; received a sentence for; pled nolo contendere (no contest) to; been placed on probation, fined, or entered into a pretrial intervention for; or had adjudication withheld by any judicial body for any crime other than a minor traffic violation? (Any criminal record not disclosed by you may be considered falsification of this application, which may result in revocation of your employment offer or termination of your employment. Also, in accordance with state or federal regulations, you may be required to provide copies of any criminal records. Answering “yes” to this question is not an automatic bar to employment.)*

Yes

No

If yes, describe the details of the conviction or other disposition of the charge, the date of the offense (month and year), your age at the time of the offense, and life changes you’ve made since the offense date.

Have you ever been disciplined or terminated from any job for an act of violence, harassment, discrimination, ethical breach, or theft?*

Yes

No

Have you ever been a defendant in a civil action for an intentional tort (i.e., assault, battery, false imprisonment, infliction of emotional distress, fraud and misrepresentation, or others)?*

Yes

No

Do you currently have any criminal charges pending against you?*

Yes

No

Are you currently wanted by any law enforcement agency?*

Yes

No

If you answered “yes” to any of the above four questions, please describe the details of incident including charges against you, dates, locations, and current status.

Driving History

Answer the following questions only if you are applying for a position which may require operation of a vehicle for company purposes.

Do you have a valid driver's license?

Yes

No

From what State?

Have you been convicted of any moving violations in the past three years?

Yes

No

Provide date(s), location(s) and reason(s):

Has your license ever been revoked or suspended?

Yes

No

Provide date(s), location(s) and reason(s):

Educational Background

Highschool or GED*

Name and location of school, years attended

Did you graduate?*

Yes

No

Trade, Business, or Technical

Name and location of school, years attended

Did you graduate?

Yes

No

Degree received and major subject

College

Name and location of school, years attended

Did you graduate?

Yes

No

Degree received and major subject

Work History and Any Employment Gaps

This section must be completed in full even if a resume is included. List your most recent job first and provide a complete work history including military service. Request additional pages if necessary to provide a complete work history. All gaps must be explained.

Most recent: 1 | Company Name*

1 | Phone

1 | Date employed from

1 | Date employed to

1 | Address

Street AddressCityStateZIP Code

1 | Job Title

1 | Name of Supervisor

1 | Reason for leaving

1 | Hourly Rate or Salary

1 | Choose One

Resigned

Terminated

1 | Summarize work performed and job responsibilities.

2 | Company Name

2 | Phone

2 | Date employed from

2 | Date employed to

2 | Address

Street AddressCityStateZIP Code

2 | Job Title

2 | Name of Supervisor

2 | Reason for leaving

2 | Hourly Rate or Salary

2 | Choose One

Resigned

Terminated

2 | Summarize work performed and job responsibilities.

3 | Company Name

3 | Phone

3 | Date employed from

3 | Date employed to

3 | Address

Street AddressCityStateZIP Code

3 | Job Title

3 | Name of Supervisor

3 | Reason for leaving

3 | Hourly Rate or Salary

3 | Choose One

Resigned

Terminated

3 | Summarize work performed and job responsibilities.

4 | Company Name

4 | Phone

4 | Date employed from

4 | Date employed to

4 | Address

Street AddressCityStateZIP Code

4 | Job Title

4 | Name of Supervisor

4 | Reason for leaving

4 | Hourly Rate or Salary

4 | Choose One

Resigned

Terminated

4 | Summarize work performed and job responsibilities.

Personal References

Name

(include how long you have known this person)

Contact Phone

Name

(include how long you have known this person)

Contact Phone

Name

(include how long you have known this person)

Contact Phone

Agreement and Release

For the purpose of this agreement and release, Wayne Automatic Fire Sprinklers, Inc. is referred to as “the company,” “this company,” or “you.” The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application (even if discovered after employment) or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit, social media, and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer a personality profile or other pre-employment tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment, and I agree to submit to a medical evaluation, if required. I consent to the release of any or all medical information or records deemed necessary to determine my capability to perform the essential job functions of the position for which I may hold. I also consent to periodic background check reports after hire which could include criminal background checks, motor vehicle record checks, criminal checks, and all others.
In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. In exchange for the consideration of my employment application by Wayne Automatic Fire Sprinklers, Inc., I hereby release and forever discharge this company (including its directors, officers, employees, and agents) and my past and/or present employers (including their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize past employers, doctors, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.
I understand that if my application is accepted that employment with this company at all times is employment “at will." It is further understood that this “at will” relationship may not be changed by any written document, verbal statements, or by conduct unless an authorized executive of this company specifically acknowledges such change. I further understand that my “at will” employment may be terminated at any time by this company or myself and includes no guarantee, contract, or promise of employment for any specific length of time. I understand that the first 90 days of employment is a new-hire introductory period. If I am terminated for poor job performance during my introductory period, I understand that I will be ineligible for unemployment compensation benefits.
I have read, understand, and by my signature consent to these statements.